The Right to Self-Determination: Freedom from Involuntary Sterilization

One of the most notorious decisions of the Supreme Court was its 1927 decision in Buck v. Bell, 274 U.S. 200, in which Chief Justice Oliver Wendell Holmes upheld the involuntary sterilization of a woman deemed “feeble-minded”[1] with the chilling justification that “Three generations of imbeciles are enough.”[2] With only one dissent (Mr. Justice Butler), the Supreme Court rejected Carrie Bell’s arguments that this practice violated the Eighth and Fourteenth Amendments to the U.S. Constitution. . (The Eighth Amendment protects U.S. citizens from “cruel and unusual punishment.” The Fourteenth Amendment prohibits a state from denying “any person within its jurisdiction the equal protection of the law.”) Although Buck v. Bell has never been overturned, state statutes such as the one upheld in Buck v. Bell have been repealed, and its reasoning has been undermined by a subsequent Supreme Court decision striking down a law providing for involuntary sterilization of criminals.

The “Science” of Eugenics

Buck v. Bell reflected the misconceptions and beliefs of the times. During the early to mid-1900s, dehumanization of people with developmental disabilities was widespread, due largely to public support for “eugenics.” Eugenicists believe that the human race can be improved by controlling reproduction as a way of “cleansing” the human gene pool of negative or less desirable traits found in “less desirable” people, particularly those with developmental disabilities, mental illness or those who were considered ‘immoral’ or had criminal histories.

The Eugenics Movement grew out of faulty research conducted by Dr. Henry Goddard in the early 1900s. Goddard claimed that heredity was a primary determinant of cognitive and moral disabilities. His findings strengthened the widely-held belief that people with disabilities were a “menace” and threat to society. Goddard’s infamous study of the Kallikak family supported mandatory sterilization laws, restrictions on marriage, further segregation and the loss of basic rights for people with disabilities.

Eugenics was taken to the extreme in Germany in the 1940s where Adolph Hitler ordered mass killings of up to 250,000 children and adults with developmental and physical disabilities while thousands of others were used as subjects for medical experiments. Not surprisingly, these deaths and abuses caused no outcry because the victims were generally outcasts. Soon, Hitler furthered his efforts to create a perfect race by eliminating other “undesirables” through the systematic murder of nearly 7 million people.

Mandatory Sterilization Laws in the United States

Laws requiring sterilization of citizens deemed “unfit” have been passed throughout the 20th century. The first state sterilization law was passed in Indiana in 1907 to prevent “…the procreation of confirmed criminals, idiots, imbeciles, and rapists.”[3] By the end of the 1970s, most states had repealed their sterilization laws. In the early years of the 21st century, Virginia, Oregon, North Carolina, South Carolina, California, Georgia, and Minnesota, apologized for passing these laws in the first place.

In 1914 the Eugenics Record Office (ERO) in Cold Spring Harbor, New York attempted to put an end to ongoing court challenges by designing a model eugenics law. This model law provided the basis of the 1924 Virginia statute challenged in Buck v. Bell.

The Beginnings of Buck v. Bell

In the early 1900s, the superintendent of the Virginia State Colony for Epileptics and the Feeble-Minded ordered residents to be sterilized. However, the legislation establishing the Colony did not clearly state whether or not sterilization was allowed. After a 1918 court ruling indicated that the superintendent was personally liable for the sterilizations, he discontinued the practice but began pushing for legislation that would allow residents to be sterilized without putting him at personal risk. In 1924, the state passed legislation that allowed residents to be released from the institution on the condition that they were sterilized first.

Carrie Buck was a 17-year-old woman who became pregnant as a result of rape and her foster parents had her committed to the Colony where her mother was institutionalized. Both women were judged to be “feebleminded” and promiscuous, primarily because each had given birth to a child without being married. After Carrie’s daughter, Vivian, was born, the superintendent recommended that Carrie be sterilized. Carrie’s child, Vivian, was also judged to be “feebleminded” following a cursory examination by a social worker when she was seven months old.

The landmark Buck vs. Bell decision was rendered on May 2, 1927, at the height of the Eugenics movement. It was one of the first times that the federal courts intervened in a case involving the rights of people with developmental disabilities. Unfortunately, in this case, the outcome further limited the rights of people with disabilities by excluding them from the Constitutional protections provided by the Eighth and Fourteenth Amendments. Buck v. Bell paved the way for 30 other states to enforce such laws. As a result, more than 60,000 men, women and children in the United States were sterilized without their consent from the 1920s through the mid-1970s.

“It is better for all the world, if instead of waiting to execute degenerate offspring for crime, or let them starve for their imbecility, society can prevent those who are manifestly unfit from breeding their kind. The principle that sustains compulsory vaccination is broad enough to cover cutting Fallopian tubes…Three generations of imbeciles are enough.”[4]

In the original lawsuit, the Superintendent of the Virginia Colony, Dr. Albert Priddy, testified that members of the Buck family “belong to the shiftless, ignorant, and worthless class of anti-social whites of the South,”[5] a contention supported by prevailing eugenicists who also testified. Buck lost the case and, as a result, forced sterilization of “the feeble-minded” became legal in Virginia.

The case was appealed and eventually made its way to the U.S. Supreme Court. Upon reviewing the case, the Supreme Court rejected the argument that the law violated Carrie Buck’s constitutional right to equal protection and due process under the law and held “that Carrie Buck is the probable potential parent of socially inadequate offspring, likewise afflicted, that she may be sexually sterilized without detriment to her general health and that her welfare and that of society will be promoted by her sterilization.”[6]

In his opinion, Justice Oliver Wendell Holmes contended that if the nation could call upon its “best citizens” for their lives during war it could demand a “lesser” sacrifice of those who “sap the strength” of society.[7] He concluded his opinion with the infamous statement that “three generations of imbeciles are enough.”[8]

Skinner v. Oklahoma ex rel. Williamson, 316 U.S. 535 (1942)

Following Buck v. Bell, forced sterilization became acceptable across the nation. However, it was regularly challenged in the courts, including a 1942 lawsuit that reached the U.S. Supreme Court.

Skinner v. Oklahoma challenged Oklahoma’s Habitual Criminal Sterilization Act of 1935 on the grounds that it constituted “cruel and unusual punishment” and did not provide “equal protection.” The Supreme Court overturned the Act on “equal protection” grounds because some crimes, such as embezzlement, were excluded from the jurisdiction of the Habitual Criminal Sterilization Act.[9] Neither the Act nor the 1942 ruling had any impact on the forced sterilization of people with disabilities.

In his opinion for Skinner v. Oklahoma, Justice William O. Douglas noted that the fundamental right of procreation required close scrutiny by the courts:

We are faced with legislation which involves one of the basic rights of man. Marriage and procreation are fundamental to the very existence of the race. The power to sterilize, if exercised, may have subtle, far-reaching and devastating effects. In evil or reckless hands it can cause races of types which are inimical to the dominant group to wither and disappear. There is no redemption for the individual whom the law touches. Any experiment the state conducts is to his irreparable injury. He is forever deprived of a basic liberty.[10]

Although Skinner did not directly address the issue of forced sterilization of people with disabilities, its reasoning undermines the rationale of Buck v. Bell, and it has been cited in subsequent cases denying petitions by guardians of people with disabilities, and has led to the enactment of procedural safeguards before sterilization of people in institutional settings.

Sterilization Requests by Guardians of People with Disabilities

While most forced sterilizations historically took place in institutions, with widespread de-institutionalization, the issue of sterilization of individuals with developmental disabilities who lived in the community or with their families moved to a different arena. In cases involving petitions of guardians to approve sterilization of wards with disabilities, Courts have struggled with the issue of “consent”. Early cases tended to support the rights of parents and other guardians to approve the sterilizations of people who were considered incapable of making their own decisions, sometimes using the Fourteenth Amendment to justify its ruling, arguing that since institutionalized adults were being sterilized with the approval of substitute decision makers, denying the same “right” to people living in the community violated the right to equal protection. More recently, however, such petitions have been met with a greater sensitivity to the important privacy concerns of wards with mental disabilities who are the subjects of such petitions, insisting on a careful balancing of the right to bear children and the “fundamental right to keep one’s person inviolate from unwanted intrusions” against the considerations raised by the guardians bringing the petitions. In re Estate of K.E.J., 382 Ill. App. 3d 401 (2008); In re Lee Ann Grady, 426 A. 2d. 467 (NJ S. Ct. 1981).

WHAT HAPPENED NEXT?

Although Buck v. Bell has never been overturned, its reasoning has been thoroughly discredited by subsequent case law and a growing awareness of the need for procedural safeguards to ensure the protection of the privacy rights compromised by sterilization.

Disclaimer: The language used to describe people with developmental disabilities has changed over time. Many terms and language that are now considered disrespectful and offensive were once considered acceptable.
As people with developmental disabilities have begun to advocate for the use of “people first” language and more respectful words to describe people with disabilities in spoken and written language, terms such as “retarded,” “handicapped,” “trainable,” and “educable” have been replaced in many laws documents.
However, the remnants of what is now considered unacceptable language and terms may still be found in references to official governmental bodies (i.e. President’s Panel on Mental Retardation), organizations that were founded during these earlier years, federal laws, reports (i.e. Community Residences for Mentally Retarded Persons), case law, and quotations. These terms are used from time to time in this website, for historical accuracy.